Clenched jaw and tight teeth: causes, signs and what helps

Do you find yourself with your teeth touching while you work at the computer? Do you wake up with a tired jaw, pain near the ears or a headache at the temples? Has someone told you that you grind your teeth in your sleep? Clenching the jaw is very common and, most of the time, goes unnoticed until it gives signs.

This article explains what bruxism is, why it happens, which signs to look for and what the evidence says about what really helps.

What bruxism is

According to an international expert consensus, bruxism is a repetitive activity of the chewing muscles, which may consist of clenching or grinding the teeth, or of holding the jaw tense or thrust forward, even without contact between the teeth (Lobbezoo et al., 2018). The same consensus stresses that, in healthy people, bruxism is not a disease in itself, but a behaviour that may or may not have consequences.

There are two types with different causes and patterns:

Awake bruxism

• Above all clenching the teeth or holding the jaw tense, rarely grinding.
• It appears in moments of concentration, stress, irritation or effort: at the computer, driving, at the gym, looking at your phone.
• It is often an unconscious habit, which you can learn to recognise and reduce.
• Reviews estimate a prevalence of around 22 to 31% in adults (Manfredini et al., 2013).

Sleep bruxism

• Clenching and grinding during sleep, sometimes with noise that your partner hears.
• It is associated with micro-arousals during sleep and is regulated by the central nervous system, more than by the “bite”.
• Estimated prevalence of around 13% in adults, decreasing with age (Manfredini et al., 2013).

What contributes

• Stress and anxiety: the most cited factor, especially in awake bruxism.
• Caffeine, alcohol and tobacco: associated with more sleep bruxism.
• Sleep disorders: especially obstructive sleep apnoea and snoring.
• Some medicines: certain antidepressants (for example, selective serotonin reuptake inhibitors) and stimulants. Never stop medication on your own initiative: speak to your doctor.
• Gastro-oesophageal reflux: associated with sleep bruxism in some studies.

And what about the “crooked bite”? For a long time it was thought that occlusion problems caused bruxism. The current evidence does not support this idea, and irreversible adjustments to the teeth are not recommended to treat bruxism.

Signs and consequences

Many people only discover that they clench their teeth when one of these signs appears:

• Tired, tense or sore jaw, especially on waking or at the end of the day.
• Pain in the temples or headache on waking.
• Pain near the ears or a feeling of a “blocked” ear, with no ear problem.
• Clicking when opening the mouth.
• Sensitive, worn teeth, with cracks or restorations that break.
• Tooth marks on the tongue or inside of the cheeks.
• Bulky jaw muscles (masseter), or hard to the touch.
• Associated tension in the neck and shoulders.

The temporomandibular joint (TMJ)

The temporomandibular joint (TMJ) connects the jaw to the skull, in front of the ear. Temporomandibular disorders are a group of problems of the chewing muscles and the joint, which cause pain, limited mouth opening and noises. They are among the most common causes of facial pain. Bruxism is one of the associated factors, alongside stress, poor sleep quality and other chronic pains. Diagnosis follows standardised clinical criteria and is made by a dentist or doctor (Schiffman et al., 2014).

The link with the neck and head

The muscles of the jaw, neck and shoulders work together. Those who clench their teeth also tend to raise their shoulders and tense their neck, especially in moments of stress or concentration. That is why a clenched jaw often comes with the aches of working seated and with tension-type headache.

What helps

There is no treatment that “cures” bruxism. The goal is to reduce the behaviour, relieve pain and protect the teeth and the joint. Simple, reversible approaches are the first line.

1. Becoming aware during the day

In awake bruxism, the most useful step is learning to notice it. The resting position of the jaw is: lips together, teeth apart, tongue relaxed on the roof of the mouth, just behind the front teeth. The teeth should only touch when chewing and swallowing.

• Stick up small reminders (a coloured dot on the screen, on the car mirror) and, whenever you see them, check your jaw.
• Use alarms or reminder apps in the first few weeks.
• Notice the situations in which you clench most: emails, traffic, training, phone.

2. Managing stress and looking after sleep

• Relaxation techniques, slow breathing, regular physical exercise.
• Reduce caffeine, especially in the afternoon, and alcohol in the evening. Stop smoking.
• Regular sleep schedules.
• If you snore loudly, have pauses in breathing while asleep or wake up tired, talk to your doctor about sleep apnoea.
• In some cases, cognitive behavioural therapy and biofeedback may help.

3. Sparing the jaw

• Avoid chewing gum, biting nails, chewing pens or ice.
• In painful phases, prefer softer foods and cut them into small pieces.
• Avoid opening the mouth very wide (big yawns, very tall sandwiches).
• Moist heat on the face for 10 to 15 minutes relieves muscle tension.

4. Splint (bite guard)

A custom-made splint, made by the dentist, is used mainly at night. The evidence that it reduces bruxism itself is insufficient (Macedo et al., 2007), but it is useful to protect the teeth from wear and may relieve symptoms in some people. Generic pharmacy splints, which are soft and poorly fitted, may not help and, in some cases, increase muscle activity. The indication and fitting should be carried out by a dentist.

5. Massage and exercises

Massage of the chewing muscles (masseter and temporalis), neck and shoulders relieves muscle tension and pain. Systematic reviews show that manual therapy and therapeutic exercise reduce pain and improve mouth opening in people with temporomandibular disorder of muscular origin, especially when combined (Armijo-Olivo et al., 2016; Calixtre et al., 2015). The quality of the studies is moderate to low, but the safety profile is very good.

Simple self-massage (2 to 3 minutes, once or twice a day):

• Locate the masseter: clench your teeth and feel the muscle that hardens in front of the ear, at the angle of the jaw. Then relax.
• With two or three fingers, make small, slow circles over the muscle, with comfortable pressure, for 30 to 60 seconds on each side.
• Repeat at the temples (temporalis muscle), above and in front of the ears.
• Finish by opening and closing your mouth slowly, with the tongue on the roof of the mouth, 5 to 10 times.

Stop if the pain increases. If there is locking, painful clicking or persistent pain, see a dentist.

6. Other medical options

In selected cases, the doctor may propose other approaches, such as botulinum toxin in the chewing muscles. For this indication, its use is outside approved indications (off-label) and the evidence is still limited (De la Torre Canales et al., 2017). It is a medical decision, after assessment and an explanation of benefits and risks.

When to seek help

Book an appointment with a dentist if you have:

See a doctor quickly if you have:

Call 112 if jaw pain comes on with exertion or with chest pain, shortness of breath, sweating or feeling unwell, because it may have a cardiac origin. If in doubt, call SNS 24 (808 24 24 24).

At Luxmed Clinic

At Luxmed Clinic, in Algés, massages for jaw tension work the face, temples, neck and shoulders together. If there are signs of a dental or joint problem, we recommend assessment by a dentist, because massage complements, but does not replace, that care. Massages are carried out by a massage therapist.

Massage is a wellbeing complement and does not replace medical or dental assessment or treatment. Results vary from person to person.

Frequently asked questions